PSYCHIATRIST LOREN MOSHER RECENTLY RESIGNED IN DISGUST FROM THE American Psychiatric Association, claiming that some of his colleagues are too quick to hand out drugs in what he terms an "unholy alliance" between psychiatrists and drug companies. A substantial number of cases of misdiagnosis and fraud support his view that patient care may be in jeopardy.

But not everyone agrees. Frederick Goodwin, M.D., host of radio's The Infinite Mind and a former director of the National Institute of Mental Health, counters that volumes of research and thousands of real-life stories long ago confirmed the value of prescription drugs for psychological problems. And he has the establishment behind him. Providing testimony are the American Psychiatric Association, the principle professional association of psychiatrists in the country; the National Institute of Mental Health, the federal government's policy and research organization; and the National Alliance for the Mentally Ill, the nation's largest advocacy group for the mentally ill.

"I Want No Part of It Anymore"

The trouble began in the late 1970s when I conducted a controversial study: I opened a program--Soteria House--where newly diagnosed schizophrenic patients lived medication-free with a young, nonprofessional staff trained to listen to and understand them and provide companionship. The idea was that schizophrenia can often be overcome with the help of meaningful relationships, rather than with drugs, and that such treatment would eventually lead to unquestionably healthier lives.

The experiment worked better than expected. Over the initial six weeks, patients recovered as quickly as those treated with medication in hospitals.

The results of the study were published in scores of psychiatric journals, nursing journals and books, but the project lost its funding and the facility was closed. Amid the storm of controversy that followed, control of the research project was taken out of my hands. I also faced an investigation into my behavior as chief of the National Institute of Mental Health's Center for Studies of Schizophrenia and was excluded from prestigious academic events. By 1980, I was removed from my post altogether. All of this occurred because of my strong stand against the overuse of medication and disregard for drug-free, psychological interventions to treat psychological disorders.

I soon found a less politically sensitive position at the Uniformed Services University of the Health Sciences in Maryland. Eight years later, I re-entered the political arena as the head of the public mental health system in Montgomery County, Md., but not without a fight from friends of the drug industry. The Maryland Psychiatric Society asked that a state pharmacy committee review my credentials and prescribing practices to make sure that Montgomery County patients would receive proper--read: drug--treatments. In addition, a pro-drug family advocacy organization arranged for more than 250 furious letters to be sent to the elected county executive who had hired me. Fortunately, my employers were not drug-industry-dominated, so I kept my position.

Why does the world of psychiatry find me so threatening? Because drug companies pour millions of dollars into the pockets of psychiatrists around the country, making them reluctant to recognize that drugs may not always be in the best interest of their patients. They are too busy enjoying drug company perks: consultant gigs, research grants, fine wine and fancy meals.

Pharmaceutical companies pay through the nose to get their message across to psychiatrists across the country. They finance major symposia at the two predominant annual psychiatric conventions, offer yummy treats and music to conventioneers, and pay $1,000-$2,000 per speaker to hock their wares. It is estimated that, in total, drug companies spend an average of $10,000 per physician, per year, on education.

And, of course, the doctors-for-hire tell only half the story. How widely is it known, for example, that Prozac and its successor antidepressants cause sexual dysfunction in as many as 70% of people taking them?

What's even scarier is the greed that is directing a good deal of drug testing today It is estimated that drug manufacturers have, on average, 12 years to recoup costs and make profits on a given medication before a generic form can be made. So pressure to test new drugs mounts. In the field of psychiatric drug testing, organizations make a profit of as much as $40,000 for every patient who successfully completes a trial. And university psychiatry departments, private research clinics and some individual doctors live on this money.

The good news is that the press is catching on. The New York Times, Dallas News, Milwaukee Journal Sentinel and New York Post have recently run articles or series on how pharmaceutical companies use cash incentives to encourage doctors to prescribe their drugs.

This spring, the New York Post revealed that Columbia University has been cashing in. Its Office of Clinical Trials generates about $10 million a year testing new medications--much of which is granted to the Columbia Psychiatric Institute for implementing these tests. The director of the institute was being paid $140,000 a year by various drug companies to tour the country promoting their drugs. He also received payments of nearly $12,000 from a drug manufacturer to head up a study on panic disorders. How could he rate these drugs fairly when his livelihood was dependent on the success of the drug manufacturer? The director resigned in the aftermath of the article's publication.

At least one drug company, Wyeth-Ayerst Research, has spoken out against offering cash bonuses and other incentives to researchers. But company representatives admit it's difficult to stay competitive when other groups so eagerly violate ethical concerns.

The APA Connection

The American Psychiatric Association--representing the majority of psychiatrists in America, with about 40,000 members--is also unduly influenced by pharmaceutical dollars. The association:

* derives an enormous percentage of its income from drug companies--30% of its total budget is from drug company advertising in its many publications.

* accepts a large number of unrestricted educational grants from drug companies.

This relationship is dangerous because researchers and psychiatrists then feel indebted to the drug companies, remain biased in favor of drug cures, downplay side effects and seldom try other types Of interventions. And they know they have the unspoken blessing of the APA to do so.

Collectively, these practices aggressively promote reliance on prescription drug use--so much so that many people think drugs should be forced on those who refuse to take them. The APA supports the National Alliance for the Mentally Ill, which believes that mentally ill patients should be coerced to take medication. I am appalled by this level of social control. Mentally ill people should be given a choice to have their illness treated in alternative ways.

Over the last decade, I have written a number of letters bringing my concerns to the APA's attention but have received no response. The association claims that what it's doing is in the "best interest of patients," but its strong ties to the drug industry suggest otherwise.

Recently, it was dues-paying time for the APA, and I sat there looking at the form. I thought about the unholy alliance between the association and the drug industry. I thought about how consumers are being affected by this alliance, about the overuse of medication, about side effects and about alternative treatments. I thought about how irresponsibly some of my colleagues are acting toward the general public and the mentally ill. And I realized, I want no part of it anymore.

RELATED ARTICLE: The Other Side

"Safe and Effective Drugs Have Improved the lives of Millions"

A Response By Frederick K. Goodwin, M.D.

Dr. Mosher has seized onto the recent press interest in the relationship between the pharmaceutical industry and biomedical professionals as an opportunity to re-open a 25-year-old argument--one that has long been settled by a mass of scientific evidence and by the testimony of hundreds of thousands of patients, their families and their caregivers. The availability of safe and effective psychoactive drugs has dramatically improved the lives of millions of individuals with major mental disorders such as schizophrenia, bipolar illness, clinical depression, obsessive-compulsive disorder and panic disorder.

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